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We explored if baseline PET\u2010based characteristics would improve risk stratification. Of 166 patients enrolled in the COG AHOD0831 study, 94 (57%) had baseline PET scans evaluable for quantitative analysis. For these patients, total body metabolic tumour volume (MTV), total lesion glycolysis (TLG), maximum standardized uptake value (SUV<jats:sub>max<\/jats:sub>) and peak SUV (SUV<jats:sub>peak<\/jats:sub>) were obtained. MTV\/TLG thresholds were an SUV of 2.5 (MTV<jats:sub>2.5<\/jats:sub>\/TLG<jats:sub>2.5<\/jats:sub>) and 40% of the tumour SUV<jats:sub>max<\/jats:sub> (MTV<jats:sub>40%<\/jats:sub>\/TLG<jats:sub>40%<\/jats:sub>). TLG<jats:sub>2.5<\/jats:sub> was associated with event\u2010free survival (EFS) in the complete cohort (<jats:italic>p<\/jats:italic>\u00a0=\u20090.04) and in RERs (<jats:italic>p<\/jats:italic>\u00a0=\u20090.01), but not in SERs (<jats:italic>p<\/jats:italic>\u00a0=\u20090.8). The Youden index cut\u2010off for TLG<jats:sub>2.5<\/jats:sub> was 1841. Four\u2010year EFS was 92% for RER\/TLG<jats:sub>2.5<\/jats:sub>\u00a0up to\u20091841, 60% for RER\/TLG<jats:sub>2.5<\/jats:sub>\u00a0greater than\u20091841, 74% for SER\/TLG<jats:sub>2.5<\/jats:sub>\u00a0up to\u20091841 and 79% for SER\/TLG<jats:sub>2.5<\/jats:sub>\u00a0greater than\u20091841. Second EFS for RER\/TLG<jats:sub>2.5<\/jats:sub>\u00a0up to\u20091841 was 100%. Thus, RERs with a low baseline TLG<jats:sub>2.5<\/jats:sub> experienced excellent EFS with less intensive therapy, whereas RERs with a high baseline TLG<jats:sub>2.5<\/jats:sub> experienced poor EFS. These findings suggest that patients with a high upfront tumour burden may benefit from intensified therapy, even if they achieve a RER.<\/jats:p>","DOI":"10.1111\/bjh.18734","type":"journal-article","created":{"date-parts":[[2023,3,16]],"date-time":"2023-03-16T01:33:58Z","timestamp":1678930438000},"page":"1192-1199","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Baseline metabolic tumour burden improves risk stratification in Hodgkin lymphoma: A Children's Oncology Group study"],"prefix":"10.1111","volume":"201","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0037-6967","authenticated-orcid":false,"given":"Sarah A.","family":"Milgrom","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology University of Colorado  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jihyun","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine and Molecular Imaging, Department of Radiology University of Wisconsin School of Medicine and Public Health  Madison Wisconsin USA"},{"name":"Division of Nuclear Medicine, Department of Radiology, College of Medicine The Catholic University of Korea  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinglin","family":"Pei","sequence":"additional","affiliation":[{"name":"Children's Oncology Group, Statistics and Data Center, Department of Biostatistics University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inki","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine and Molecular Imaging, Department of Radiology University of Wisconsin School of Medicine and Public Health  Madison Wisconsin USA"},{"name":"Department of Nuclear Medicine Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2312-5418","authenticated-orcid":false,"given":"Bradford S.","family":"Hoppe","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Mayo Clinic Florida  Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Wu","sequence":"additional","affiliation":[{"name":"Children's Oncology Group, Statistics and Data Center, Department of Biostatistics University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4687-4582","authenticated-orcid":false,"given":"David","family":"Hodgson","sequence":"additional","affiliation":[{"name":"University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandy","family":"Kessel","sequence":"additional","affiliation":[{"name":"Imaging and Radiation 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